By Aly W. | First published March 26, 2019 | Last modified December 26, 2020
Last year, a case report of lactation and breastfeeding in a transgender woman was published:
- Reisman, T., & Goldstein, Z. (2018). Case report: Induced lactation in a transgender woman. Transgender Health, 3(1), 24–26. [DOI:10.1089/trgh.2017.0044]
In the paper, the authors state the following:
We believe that this is the first formal report in the medical literature of induced lactation in a transgender woman.
However, this actually wasn’t the first case report of lactation and/or breastfeeding in a transfeminine person in the literature. There are various previous published cases dating back as far as the 1950s. These instances are provided below in the format of sources and excerpts.
Based on the theories of lactogenesis and stimulated by the success of Lyons, Li, Johnson & Cole , who succeeded in producing lactation in male rats, an attempt was made to initiate lactogenesis in a male transvestist. Six years ago this patient had been given oestrogens. Both testes and penis were then removed and an artificial vagina was constructed by plastic surgery. The patient was implanted with 500 mg oestradiol in September 1954, and 600 mg in July 1955. The breasts were then developed more intensively with daily injections of oestradiol dipropionate and progesterone for 6 weeks. Immediately following withdrawal of this treatment, prolactin 22-9 mg was injected daily for 3 days without effect. After a second month on oestradiol and progesterone daily, combined injections of prolactin and somatotrophin were given for 4 days and suction was applied by a breast pump-four times daily. On the 4th and 5th days a few drops of colostrum were expressed from the right nipple.
Tindal, J. S., & McNaught, M. L. (1958). Hormonal Factors in Breast Development and Milk Secretion. In Gardiner-Hill, H. (Ed.). Modern Trends in Endocrinology, Volume 1 (pp. 188–211) (Modern Trends). London: Butterworth. [Google Books]:
Recently, an attempt has been made by Foss (1956) to initiate lactation in a castrated male transvestist. He was given an implant of 500 milligrams of oestradiol, and 10 months later, a further 600 milligrams of oestradiol, followed by daily injections of oestradiol dipropionate and progesterone for 6 weeks. Immediately after withdrawal of this treatment, 22-9 milligrams of prolactin were injected daily for 3 days but without effect. After a second month of treatment with oestradiol and progesterone daily, he was given combined injections of prolactin and somatotrophin for 4 days, suction with a breast-pump being employed 4 times daily. On the fourth and fifth days a few drops of colostrum were expressed from the right nipple. There is a possible application here of modern hormone knowledge to man, and further trials would be of interest.
Experimentally I have been able to induce lactogenesis in a male transvestite whose testes had been removed some years before and whose breasts had been well developed over a long period with stilbestrol and ethisterone.9 In July, 1955, 600 mg. of estradiol was implanted subcutaneously and weekly injections of 50 mg. of progesterone were given for four months. For the next month daily injections of 10 mg. estradiol dipropionate and 50 mg. progesterone were given. These injections were continued for another month, increasing progesterone to 100 mg. daily. Both hormones were then withdrawn, and daily injections of increasing doses of prolactin and somatotropin were given for four days; at the same time, the patient used a breast bump four times daily for 5 minutes on both sides. During this time the mammary veins were visibly enlarged and on the sixth and seventh days 1 to 2 cc. of milky fluid was collected.
Flückiger, E., Del Pozo, E., & von Werder, K. (1982). Prolactin: Synthesis, Fate and Actions. In Flückiger, E. W., Del Pozo, E., & von Werder, K. (Eds.). Prolactin: Physiology, Pharmacology, and Clinical Findings (Monographs on Endocrinology, Volume 23) (pp 1–23). Springer-Verlag, Berlin, Heidelberg. [Google Books] [DOI:10.1007/978-3-642-81721-2_1]:
An observation (Wyss and Del Pozo unpublished) in a male transsexual showed that induction of lactation can be similarly achieved in the human male.
Kozlov, G. I., Mel’nichenko, G. A., & Golubeva, I. V. (1985). Sluchai laktorei u bol’nogo muzhskogo pola s transseksualizmom. [Case of galactorrhea in a transsexual male patient.] Problemy Èndokrinologii (Moskva) [Problems of Endocrinology (Moscow)] (in Russian). 31(1), 37–38. [ISSN:0375-9660] [Google Scholar 1] [Google Scholar 2] [PMID:4039061] [DOI:10.14341/probl198531137-38] [PDF] [Translation]:
[…] At the age of 17, while working as a “nurse” in a hospital, he began to self-inject himself with folliculin (estrogen) and progesterone, which caused the development of the breasts.
At age 22, a course of treatment with cyproterone acetate was conducted at the Institute of Psychiatry of the Ministry of Health of the USSR. Muscle weakness, reduction of sexual hairiness, and appearance of colostrum excretion was noted.
On X-ray of the skull, the shape and size of the sella turcica were normal, but signs of increased intracranial pressure were revealed. […] In the study of the radioimmunoassay method using standard kits from the Sorin company, some increase in prolactin level of 24 ng/mL was detected in the serum (normal for men is 4–15 ng/mL).
[…] castration and feminizing plastic surgery of the external genitalia were performed for the purpose of social rehabilitation.
Some time after the operation, the patient developed a renewed interest in life. After the surgical and hormonal correction, the patient irresistibly developed maternal instincts. Unmarried, the patient obtained permission for the adoption of a child, simulated pregnancy, and was discharged from the maternity hospital with a son. From the first days after the “birth”, galactorrhea sharply increased, and spontaneous outflow of milk appeared, with galactorrhea (+++). The baby was breastfed up to 6 months of age.
Thus, it can be thought that several factors played a role in the genesis of galactorrhea in this patient:
Increased prolactin levels with estrogen and cyproterone acetate. The hyperprolactic properties of estrogens have long been known; the ability of cyproterone acetate to increase serum prolactin levels was shown by K. Schmidt–Golewizer et al (9).
Increased intracranial pressure, the role of this factor and the genesis of neuroendocrine disorders and, in particular, in the development of galactorrhea was shown by R. Peterson (8).
Our message is the second in the world literature describing galactorrhea in a male patient with transsexualism. The first description of this kind was made in 1983 by R. Flüskiger et al. (6). This observation demonstrates the independence of the mechanism of lactation development from one’s genetic sex and is alarming with regard to the possibility of drug-induced galactorrhea development in men.
Barber, T., Basu, A., Rizvi, K., & Chapman, J. (2004). Normoprolactinaemic galactorrhoea in a male-to-female transsexual. Endocrine Abstracts / 23rd Joint Meeting of the British Endocrine Societies with the European Federation of Endocrine Societies, Volume 7, P271. BioScientifica. [URL] [Google Scholar]:
Hormonal therapies in the form of oestrogens, anti-androgens and progestogens are often used in the treatment of male-to-female transsexuals. We present the case of a 36 year old phenotypic male with karyotype 46XY who presented with normoprolactinaemic galactorrhoea likely to be related to prior oestrogen administration. He had been self-administering oestrogen and progesterone preparations continuously for 7 years (aged 26 - 33 years) in an attempt to develop female phenotypic characteristics in spite of a heterosexual desire. During this time he developed gynaecomastia with galactorrhoea, increased energy and libido, voice change and an attraction towards both men and women. However due to lack of financial resources to secure a complete gender change, he stopped self-medication with these preparations 3 years ago. Instead he embarked on a regime involving self-administered testosterone in an attempt to reverse the biological changes. After discontinuation of oestrogen the gynaecomastia regressed somewhat, although galactorrhoea continued and worsened with testosterone. Prior to referral he had been treated with dopamine agonists with little improvement in galactorrhoea and gynaecomastia.
Routine biochemistry and haematology are within their reference ranges. Baseline endocrinology is normal: Prolactin 197 milliUnits per litre, LH 2.9 Units per litre, FSH 7.9 Units per litre, free Testosterone 20 nanoMoles per litre, 17 beta-oestradiol less than 110 picoMoles per litre, TSH 0.96 milliUnits per litre and free T4 16.5 picoMoles per litre.
This case illustrates fascinating effects of exogenous oestrogen in the male. The effects of oestrogenic products of aromatised endogenous and briefly also exogenous testosterone acting on oestrogen-primed breast tissue may account for, at least in part, his continuing symptom of normoprolactinaemic galactorrhoea. However two other features do not have any direct explanations: the development of osteopenia during this period, and complete disappearance of vascular migraine, a condition worsened with oestrogens in the female. He is now on Tamoxifen although an opportunity to use the aromatase inhibitor, Anastrozole still remains.
Moravek, M. B., & Pasque, K. B. (2019, March). T-055 Lactation Can Be Successfully Induced in Transgender Women While Maintaining Gender-Congruent Serum Hormone Levels. Reproductive Sciences, 26(Suppl 1), 136A–136A. [Google Scholar] [DOI:10.1177/1933719119834079]:
Introduction: Transgender women may be interested in breastfeeding their children, but there are no established protocols for lactation induction in this population. The only case report of a lactation induction protocol in a transgender woman significantly lowered her estradiol dose, which would likely result in decreased serum estradiol and increased testosterone levels, with resultant increase in gender dysphoria. Our objective was to induce lactation in a transgender woman without interrupting her gendercongruent hormone profile.
Methods: A 34-year-old transgender woman with a 15-year history of gender-affirming hormone therapy with estradiol and spironolactone presented for lactation induction once her cisgender wife conceived. A modification of the Newman-Goldfarb method for adoptive mothers was used to induce lactation, and serum hormone levels followed.
Results: Baseline labs were obtained (time point 1), then medroxyprogesterone 1.25mg daily was added to her existing hormone regimen of estradiol 6mg daily and spironolactone 100mg twice daily (time point 2). Domperidone 10mg four times daily was initiated 1 month later. Approximately 5 weeks prior to the due date, the patient stopped medroxyprogesterone, decreased estradiol to 2mg daily, and began breast pumping (time point 3). Just prior to the infant’s birth, the patient was pumping 2-3 ounces of breastmilk every 3 hours (time point 4). Spironolactone was decreased to 50mg twice daily. Her son was born at term, via uncomplicated vaginal delivery. The infant was able to breastfeed from both mothers without difficulty, with both mothers pumping when they weren’t actively breastfeeding to maintain supply (time point 5). When the infant was approximately 2 months old, the patient noticed an increase in facial hair growth. Estradiol was increased to 3mg daily and spironolactone increased to 100mg twice daily, with resolution of hair growth and no decrease in milk supply (time point 6). The patient continued to breastfeed on this regimen for >6 months following her son’s birth. Serum hormone levels on the hormone regimens referenced at each time point throughout the patient’s course are displayed in table 1.
Conclusion: Lactation can be successfully induced in transgender women, without a significant decrease in estradiol supplementation. This regimen allows transgender women to breastfeed without developing male secondary sex characteristics incongruent with their gender identity
Table 1 Hormone profile at different time points.
Time Point Estradiol (pg/mL) Progesterone (ng/mL) Testosterone (ng/mL) Prolactin (ng/mL) 1 114 1.1 0.36 2 130 1.1 0.05 9 3 30 1.3 0.06 152 4 39 5 29 1.4 0.89 184 6 51 0.16 59
Unnithan, R., Elson, D. F., & Shenker, Y. (2020). SUN-043 Galactorrhea and Hyperprolactinemia in a Transgender Female. Journal of the Endocrine Society, 4(Suppl 1), A899–A899. [DOI:10.1210/jendso/bvaa046.1781]:
Background: Galactorrhea is a rare manifestation of hyper-prolactinemia in males and post-menopausal females, however the hormonal milieu of the transgender female may increase its incidence
Clinical Case: A 43 year old transgender female presented with three years of bilateral breast discharge. She had chronic, stable headaches and fatigue, but no vision changes or other symptoms. Notably, she had breast augmentation surgery with saline breast implants placed shortly before the galactorrhea commenced. She was on a stable dose of estradiol tablets 1 mg twice daily for six years. On physical exam she had pronounced bilateral breast discharge of a milky quality with nipple compression. Prolactin levels were checked several times and were 40-50 ng/mL, TSH was 2.36 uIU/mL. An MRI showed a left inferior pituitary lesion measuring 6 mm x 3 mm x 5 mm with no mass effect on adjacent structures. Her breast discharge was not bothersome to her, and her pituitary lesion was small. It was unclear whether there was a relationship between her prolactin levels and the lesion seen on MRI, as we expected more pronounced prolactin elevation with a prolactinoma. Instead, given the timing of her symptoms in relation to her breast augmentation surgery, her galactorrhea and hyper-prolactinemia were thought to be the result of nipple irritation related to her breast implants combined with a hyper-estrogenemic state.
Clinical Lessons: In the setting of a prolactin secreting micro-adenoma, galactorrhea in a male is highly unusual. This case highlights the importance of recognizing that the unique medical and surgical characteristics of male to female transgender patients can lead to hyper-prolactinemia and galactorrhea.
Reference: Reisman T, Goldstein Z. Case report: induced lactation in a transgender woman. Transgender Health. 2018;3(1):24-26.
Dr. Christine McGinn induced a pseudopregnancy and breastfed her twins with her cisgender lesbian partner. This was described in the media, including in books and television. Dr. McGinn’s case was never formally published as a case report in the scientific literature however.
Terry, J. C. (Director) & Winfrey, O. G. (Presenter). (2010 September 29). The Mom Who “Fathered” Her Own Children, Plus the Cast of Modern Family [Television series episode]. The Oprah Winfrey Show (Season 25, Episode 13). Chicago, Illinois: Harpo Studios. [URL 1] [URL 2] [URL 3] [TV Guide]
Boylan, J. F. (2014). Dr. Christine McGinn. In Boylan, J. F. Stuck in the Middle with You: A Memoir of Parenting in Three Genders (pp. 223–233). Broadway Books. [Google Books 1] [Google Books 2] [Amazon] [PDF]:
Dr. Christine McGinn is a surgeon, a mother of two, a backup flight surgeon for the space shuttle progarm, and a transgender woman. As a man, she saved her sperm before transition; ten years later she used that sperm to have children with her partner Lisa. The two of them are both biological mothers of their son and daughter, and each mother was able to breast-feed the twins. I sat down with Christine at her office in New Hope, Pennsylvania, on a hot summer day in 2011.
CM: […] Then there’s the scientist in me that knows that there is a difference, there is not a binary, but a gender spectrum. There are chemicals that are different in men and women. And when a transgender woman transitions, we are somewhere in the middle. Especialy having gone through a simulated pregnancy, in order to breast-feed, I felt the changes of those hormones. I felt my milk let down when not only my baby would cry, but a baby on TV would cry, and even, ridiculously, when a door would close and make a squeak.
JFB: You had to induce a false pregnancy in order to breast-feed? Tell me how you did that.
CM: As a doctor, I knew it was possible. I followed the protocol that involves simulating pregnancy with hormones. It’s estrogen and progesterone. My simulation pregnancy was over a month before Lisa delivered—with twins, we were expecting them to be born earlier. That entire month I was just pumping nonstop, every two hours. We had a whole freezer full of milk. And you know, the first couple of weeks it was no good, because it had all of the hormones in it. So we only saved, like, the last week or so. But still, it was a freezer full of milk.
Lisa had no idea about the way breast-feeding takes over your life, because this was her first. It was kind of funny that I went through that on my own, first, weeks before she did. And then it took her a couple of days to actually—for her milk to let down.
The children were so small when they were born. They were only five pounds. At first we had to feed them with a syringe. They were breast-feeding as well, but they weren’t latching that great on either of us.
JFB: What was it like when they finally muckled on to you?
CM: Oh, I can’t even put it in words. I really cannot put it in words. It was—I was just—oh.
JFB: Were you amazed? Were you afraid?
CM: It was heaven. I was afraid. I don’t know, it was uncharted territory. Like, I knew the milk was good. Lisa was a little concerned that it would be like skimmed milk, or something, you know. [Laughs] Like—she’s like, “Is it the same stuff?”
JFB: Is it the same milk?
CM: And she was a little dubious about, like, is this really all right? I think that’s totally natural for a mother, to be concerned.
I will just say that there are things snobody thinks about when two women are both breast-feeding. Like, technical stuff that you don’t think about. When you have a mother and a father, the mother decides when the kids get fed. Right? The father doesn’t, really. Right?
But you know, when you have two women who are filled with pregnancy hormones and have that, like, mother-bear attitude about how things should be done… It was really crazy.
JFB: So did that cause serious conflict between you and Lisa?
CM: Totally not serious conflict, because the most important thing are the babies.
Eden finally latched—I breast-fed her more than Luke. Luke was never really good. Lisa hated breast-feeding. Eventually we decided to stop.
I’m putting on my science hat again—when you decide to stop, there are hormonal issues. The strongest emotion a person can feel in their life comes frm oxytocin, which is the love drug.
CM: That’s what’s responsible for babies’ bonding during breastfeeding. So the baby latches on, breast-feeds, your brain just [makes oozing sounds], just like, oozes this gooey love substance, oxytocin. Fathers are proven to have higher oxytocin before the delivery, and just stroking your child’s head. You know, when the baby—when you smell a newborn’s head, it really—that smell, it’s like—
JFB: I just saw a friend’s newborn on Friday, and I was like, [makes sniffing sound]—
CM: My niece said it best. She came in and smell them, and she was five years old at the time, and she’s like, “They smell like cupcakes.” [Laughs] And it’s universal. When you ask me what that’s like, I can’t describe it, you know, and I’m a huge fan of food and cupcakes and chocolate, and so that’s the closest I can come to it—it’s like chocolate. [Laughs]
JFB: So when you stopped breast-feeding, was it a kind of a mourning, a loss?
CM: Yes. Lisa wanted to stop before I did. The problem is, once a baby gets a nipple, a plastic nipple, it gives more milk. And so they don’t have to work as hard.
It’s a unique situation that two breast-feeders in a relationship would experience, but a mother and father would not.
JFB: So did one of you stop breast-feeding before the other?
CM: Yes, Lisa did.
JFB: Lisa stopped. And how much longer did you keep it up?
CM: Not long, because they got the nipple.
They were both so small. We weren’t all that successful at it. We were so worried about their birth weight, and making sure they got enough with the syringes. There were definitely times where, you know, we both would breast-feed and, man, I will never forget that. Like, three ‘clock in the morning, four o’clock in the morning, in the little cocoon, nursing.
The heat of their body, their naked body on your chest. The amazing thing is, it really does kind of hurt when they really get going, you know. And you just… I don’t know how else to describe it. You feel like the life force is just coming out through you. It’s so powerful. It relieves that pain that you have in your breast. It releases that oxytocin, and it’s just—it’s even.
JFB: Did you ever do that thing where you would fall asleep with the children in the bed, and wake up with the children in the bed beside you?
JFB: I loved that. It’s one of my stnogest memories of being a father. Having gotten up in the middle of the night. And they are so small, but such an incredibly powerful feeling, the two of you together surrounding the child. With us, we also had a dog at the bottom of the bed. [Laughs]
CM: And we have two, and that was also very important to me, too. We have miniature pinschers.
JFB: So how many months along did you stop breast-feeding?
CM: Three months. It was really emotionally painful, and I cried a lot. I was really sad.
I was pretty sure we were not going to have any more kids. So I’m like, “This is it.” It was very sad.
JFB: Is there a moment frm the last year and two months where you think, This is what it’s like to be a mother, this is it?
CM: Yes, immediately. It was hot as Hades outside. It was, like, a million degrees. We had just had the kids. It was like, May or June, and my mom was over, and it was, like, we had all this help, initially, because Lisa and I were just not getting any sleep and it was, like, round-the-clock feedings and the kids were small, and Lucas had an apnea monitor that he had to wear all the time, and it was just really hard. And there was a big thunderstorm, and the power went out.
And so, at this point, they weren’t really latching very well, so we both had to pump, and then feed them with the syringes. So Lisa and I are totally, like, engorged with milk. And the power’s out, and the pumps are electric. Right?
CM: So there’s no electricity, it’s hot as hell, we’re worried for the kids. Lisa and I are in pain. We’re both leaking. And it was the weirdest, funniest situation. And my mom’s there. She runs out to the store to get batteries, and you know, she’s just beng a mom. She’s getting everything, running around like an angel. And Lisa and I are in pain we’re miserable. When she finally came back, the batteries wouldn’t work on the pumps—something else was wrong. Lisa and I are dying.
And so, here’s the guy part of me… I get the pump that has the backup battery power and the backup car charger. Like, I got all tech on it. [Laughs] I’m out int he car trying to get the car charger to work on the pump in the pouring rain. And it’s ninety-five degrees out. It’s all wet inside, like, the humidity on the windows.
And I’m just trying to get some kind of relief.
And this stupid pump didn’t work that way, either. We come back in and my mom has candles lit.
And then the electricity comes back on. And we all just laugh and pump and breast-feed. And every one of us is in heaven.
Pfeffer, C. A. (2017). Queering Families: The Postmodern Partnerships of Cisgender Women and Transgender Men (p. 19). Oxford University Press. [Google Books]:
Just 2 years later, Winfrey would feature another interview that elicited many of the same audience reactions. In this 2010 episode, lesbian partners Dr. Christine McGinn and Lisa Bortz beamed with joy as they held their infant twins. Again, audience members’ jaws dropped when it was revealed that beautiful Christine was a male-to-female transsexual who used to be a handsome military officer Chris, and that Lisa had given birth to the couple’s biological children using sperm Chris banked prior to gender confirmation surgeries.10 And it was Winfrey’s chin that nearly hit the floor as she watched video of Christine breastfeeding the couples’ children (the episode is referred to online as “The Mom Who Fathered Her Own Children”).
Estrogen plus cyproterone acetate has been reported to produce pregnancy-like breast changes (lobuloalveolar development of the breasts) in transfeminine people (Kanhai et al., 2000). Accordingly, galactorrhea (unexpected/spontaneous or excessive lactation) has been reported as a low-incidence side effect (7–14%) of hormone therapy regimens containing estrogen plus cyproterone acetate in transfeminine people (Gooren, Harmsen-Louman, & van Kessel, 1985; Schlatterer et al., 1998; Bazarra-Castro, 2009). It has also been reported at low incidence (6%) for other hormone therapy regimens (Futterweit, 1980). Sudden cessation of hormone therapy regimens including cyproterone acetate has been reported to result in the onset of lactation as well (Levy, Crown, & Reid, 2003).
Many unpublished reports of lactation and breastfeeding in transfeminine people have additionally been described on the web including at the following pages:
- Richards, A. (2003). Lactation and the Transsexual Woman. Second Type Woman. [Updated August 2018] [URL] [PDF]
- MacDonald, T. (2013). Trans Women and Breastfeeding: A Personal Interview. Milk Junkies. [URL]
- MacDonald, T. (2013). Trans Women and Breastfeeding: The Health Care Provider. Milk Junkies. [URL]
- MacDonald, T. (2017). Jenna’s Breastfeeding Journey: Trans Motherhood. Milk Junkies. [URL]
- Burns, K. (2018). Yes, Trans Women Can Breastfeed — Here’s How. them. [URL]
Induction of lactation has also been reported in cisgender men and is noteworthy:
Geschickter, C. F. (1945). Endocrine Physiology of the Breast. In Geschickter, C. F. Diseases of the Breast: Diagnosis, Pathology, Treatment, 2nd Edition (pp. 42–81). JB Lippincott. [Google Scholar] [Google Books] [PDF]:
The results obtained indicate that a lactogenic substance in anterior pituitary extracts may cause mammary secretion in nonpregnant women when they have been previously stimulated with estrogenic hormone but true lactation does not occur. Secretion was also obtained in two adult men with gynecomastia after injections of lactogenic hormone.
Huggins, C. (1949). Endocrine substances in the treatment of cancers. Journal of the American Medical Association, 141(11), 750–754. [DOI:10.1001/jama.1949.02910110002002]:
The administration of estrogen in effective amounts causes testicular atrophy and mammary hypertrophy. Growth of the breasts can be so extensive that lactation may be induced, as illustrated in the following case.
W. N., aged 64, had carcinoma of the prostate with osseous metastases, for which he was treated by a permanent suprapubic cystotomy in 1941. Diethylstilbestrol, 20 mg. daily, was given orally for two years beginning September 1942. In September 1944, 25 mg. (500 international units) of prolactin14 was injected daily for five days, and at the end of this time creamy milk could be expressed from both breasts. Orchiectomy and removal of the cystostomy tube were carried out September 6, when administration of estrogen was discontinued; both incisions healed promptly. Since then the patient has been clinically well but has continued to lactate, a large drop of milk being easily expressed from each breast at frequent intervals.
Huggins, C., & Dao, T. L. (1954). Lactation induced by luteotrophin in women with mammary cancer. Growth of the breast of the human male following estrogenic treatment. Cancer Research, 14(4), 303–306. [URL]:
In the observations to be presented luteotrophin [prolactin] was employed as a stimulus for mammary secretion in patients with cancer of the breast, and the results throw new light on the physiology of women bearing this neoplasm. We shall also describe conditions which resulted in the induction of physiologic maturity in the human male, since knowledge of the action of hormones on the human breast is vague.
The effects of luteotrophin on the breast of women post partum has been extensively investigated, but otherwise few observations have been made in the human. Werner (14) administered a crude pituitary extract containing luteotrophin to eight castrate women 21–35 years of age; lactation was not observed, although in one woman “a few drops of colostrum-like fluid” could be expressed from the breasts. Goldzieher (4) treated menstrual disorders in women with luteotrophin, but mammary secretion was not described by him.
Luteotrophin,1 dissolved in physiological saline made slight ly alkaline (pH 9) with sodium hydroxide, was injected subcutaneously in daily amounts of 500 International Units; the solutions were freshly prepared, and the injections were continued for 7 days only.
This series comprised 21 female patients who had dis seminated mammary cancer, and all had been subjected to unilateral mastectomy. There were also three men with advanced prostatic carcinoma who had been treated for thera peutic purposes with oral diethylstilbestrol for 20 months, 2, and 6 years, respectively. There were eight persons without mammary or prostatic cancers who served as controls.
In each case of mammary cancer a biopsy of the breast was obtained for histological purposes, the material being stained with Sudan III.3
Lactation, when it occurred, was never profuse; it varied from a tiny drop to ca. 0.5 cc. from each breast. Clear colostrum was not observed, and the mammary secretion was always milk, as defined above.
Mammary growth in the human male.—Estrogenic substances had been administered to three men in the treatment of disseminated prostate cancer for many months; after luteotrophin injection two lactated and one did not lactate.
W. N. (reported in brief earlier ), age 64, had taken diethylstilbestrol, 20 mg/day, orally for 2 years, after which interval sub-areolar button-like masses of mammary tissue could be palpated bilaterally; luteotrophin was then injected for 5 days, and milk was expressed from the breast on the 6th day. Orchiectomy was then performed, and both luteotrophin and estrogenic substances were discontinued. This man continued to lactate for 7 years when the formation of milk gradually ceased.
In the case of A. W., age 62, diethylstilbestrol (5–15 mg/day) had been ingested for 20 months after bilateral orchiectomy; the breasts became slightly enlarged. Luteotrophin was injected, and lactation occurred on the 7th day. A biopsy of the breast showed moderately well developed mammary ducts and alveoli containing milk. In the case of E. G., age 59, diethylstilbestrol (5 mg/day) was ingested almost continuously for 6 years; this resulted in the development of large pendulous breasts, but no lactation occurred after injections of luteotrophin.
Lactation in humans without cancer.—Luteotrophin was administered to two normal males, age 51 and 59, and to four normal females, age 84–59, and none lactated.
It must be emphasized that lactation was not copious in any of the humans when it had been induced by luteotrophin; merely small amounts of milk were obtained. It was apparent, however, from the histological studies of the mammary tissue obtained by biopsy that the secretion of milk in any quantity was a criterion of maturity of mammary epithelium.
In the goat and guinea pig it is known that estrogenic substances can induce mammary ma turity without the intervention of exogenous synergistic steroids. In the experiments of Lewis and Turner (9) diethylstilbestrol was implanted in two castrate male goats; one of these animals failed to lactate, while the other produced a small quantity of milk without luteotrophin injections. They obtained small amounts of milk from a male kid similarly treated. Nelson (10) found that estrone induced mammary growth with, later, lactation in the male guinea pig. Our observations demonstrate that diethylstilbestrol ingested for prolonged periods of time can induce maturity of the breast in certain elderly human males. However, the human male differs from the animals just described in that spontaneous lactation was not observed; the injection of luteotrophin was necessary for milk formation.
The duration of lactation induced by luteo trophin was impressive, since milk commonly persisted for many months—and in one male for 7 years. The mechanism whereby this type of lactation is maintained for such long periods of time is at present unknown; we know that milk continues to be secreted both in the presence of the adrenal glands and in the absence of these structures and the gonads as well. Observations (8) have been made on experimental animals which are analogous to the clinical findings; most dogs with spontaneous mammary cancer possess lactation, and this characteristic persists for many months, at least, despite the removal of the adrenal glands and the ovaries.
The breast of the human male can be induced to grow to a functionally mature state by the administration of estrogenic substances without additional exogenous steroid synergists. Spontaneous lactation was not observed in these men, but it was induced by luteotrophin.
The formation of milk in any amount by the breast is a criterion of functional maturity of the mammary epithelium. Luteotrophin induced the secretion of small amounts of milk in a group of women with mammary cancer and in a number of healthy women as well, and, in addition, in two human males to whom estrogenic substances had been administered for therapeutic purposes. Lactation did not occur in two normal males.
When lactation was induced in human beings, the secretion often persisted for many months; it lasted for 7 years in one man.
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